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[BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANK_AUDIO] [BLANK_AUDIO] [BLANK_AUDIO] [BLANK_AUDIO] [BLANK_AUDIO] [BLANK_AUDIO] [BLANK_AUDIO] [BLANK_AUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] And we did two presentations at the recent Southeast England ADPH Public Health Conference. Actually, we had eight presentations overall, which was a record for any local authority in Southeast England. And two of them were on this area. So one was on tackling complex public health issues for improving dad's perinatal experience, and the other one was through mother's eyes. And that's using co-discovery and co-creation to understand barriers and motivators to breastfeeding among the most deprived communities in Kent. We also launched 24-hour text and phone line for those with low to moderate perinatal mental health needs. This was done in October, and a social media campaign has been taking place for the record. The text is 85258, and the free phone is 0800 107 0160. So that's the free phone line for people who may want to speak to someone. We also are currently in the midst of our public health transformation program. That's a root and branch look at all public health programs to see how we can do it better, more efficiently and in a more collaborative way. So that is going on at speed right now, and a lot of work is happening. The sustainability beyond year three is also wrapped into, especially the note to 19 aspect of that transformation program. Colleagues here also will be aware of national legislation that is in the process of going through parliament with tobacco control, specifically called the Smoke Free Generation, and letters have been sent to our MPs from this council in support of the legislation, as well as the ICB has also separately sent out letters. And I'm to believe that trusts have done the same as well, some trusts. We have received about 1.9 million pounds additional grant for public health to do work in this area, and that is a five-year grant, so it's 1.9 million for the next five years. It is a ring-fenced grant, and it is to increase the rates of quits, as well as reduce the prevalence of smoking. Current prevalence in Kent is 11.6%, but we've got lots of different inclusion groups where the rates are actually much higher and certain socioeconomic groups as well as occupation groups. The aim in Kent is to, it's quite a difficult ask, but we are up to the challenge, is to have 26,937 additional quits in the next five years. So that works out to about 1,340 quits set in the first year, and a 25%, this is a 25% increase on the current performance. But all exciting, because it's a big opportunity to do things differently and do it well. Related to that is vaping, colleagues might have seen in the news that it's in the news at the University of Kent, and WHO survey on young people's behaviors in terms of smoking, alcohol and other consumptions. We are doing a survey of our own, and that's currently going on in Kent schools, to establish the extent of young people vaping in Kent and compare with how it differs from the national picture, because there was a national survey done in 2023. This information will be used to target clear, helpful public health messages, support schools and key partners and agencies, and understand this whole issue better and work with young people and their parents as well. So far, 31 schools have confirmed all with sixth form and have signed up, and this should generate around 6,510 surveys at the moment. We're working on public mental health, and this is really about trying to get the low-level mental health services in Kent into a better place, and the idea is to do a mental health needs assessment in order to inform that going forward. We're also progressing in different districts with a healthy alliance model, and the TANET Health Alliance is linking with the Community Mental Health Transformation Program in TANET in order to prioritize mental health in TANET area. I've been told by my consultant that if the inequality in TANET in relation to mental health is reduced, that automatically will wipe out the health inequality over all of Kent. So that just shows the extent to which it's affected in Kent. We're pleased to announce the launch of the 24/25 Better Mental Health and Wellbeing Community Fund. This offers grants to support mental health and well-being initiatives in Kent and Medway. The fund aims to test innovative ideas and develop evidence of what works, also supports grassroot projects to continue to serve their communities. Deadline for application is the 29th of April. We're doing a lot more work in substance misuse as well. There's been a launch of the Kent substance misuse-lived experience research organization. It's called Kent Rawr, and it's going to be a useful addition to what we do. I said about the health alliances before, so Kent is building on that, and now we have currently 11 healthy alliances in existence in our 12 districts and boroughs. We're also doing more work on developing the local plans, but we'll come to that in more detail when we talk about the shared delivery plan. We're also doing quite a lot of work with adult social care to really create a different proposition for prevention, with the aim of reducing demand on adult social care, but also providing initiatives and care to our residents closer to home at the right levels. And we're also courtesy of work, which actually went on with the Cabinet Committee, doing some really focused work with Gypsy Roma Traveler community. Just wanted to end on a statutory requirement of this board that is coming up. That's for a future agenda item, and that's the pharmaceutical needs assessment. We have to publish it every three years, and the due date for publishing that would be October 2025, so we're starting the work to do with that, and we'd like to bring that back here in due course. So, I'll end there, Chair. Thank you, Dr. Gosh. We've got any questions? Gypsy? I just want to ask you said that there is 11 health alliances, and there's only one area that we don't have one. That just went off what area that was. Swin? No further questions? Fantastic. You talked about the fact that you were doing additional and more work on substance abuse. So, is that in response to particular statistics, circumstances, or is it because we haven't done enough when we're doing more? What's the rationale behind that? There's been a, probably heard of this, the Dame Carobak Review, which is an incredible piece of work, which is a 10-year strategy around tackling substance misuse drugs and alcohol. Kent performs better than many places, but we still have challenges around drug deaths and also around inpatient admissions. As in, the thinking is the more people you can get into inpatient admissions and in terms of being in the system for care, the less there will be drug deaths. So, there's a lot of work going on to boost those numbers. Now, the government has given us, not just us, all local authorities' additional money, and that reflects part of what the Dame Carobak Black Review came back with is around. Before this period, there was a sustained period of disinvestment in substance misuse. So, this is sort of correcting that and bringing back the level, not quite to the same level, but somewhat comparable to how it was before. So, this is the attempt to put that right, basically. There's another thing which is going on, and these things keep happening, that it's, again, in the news about night disease. So, this is a kind of synthetic drug, which is a killer, basically. So, it's mixed with additives, and this has caused a number of deaths, including incant. So, there are all these kind of additional challenges coming up, which we have to also think of how we address. So, this is to do what we do more and wider. OK, I can't see any other hands up, so thank you very much for your verbal update there. Everyone, happy to note that. Thank you, thank you. So, we will move on to item 9, the Kent and Midway Integrated Care Strategy, and joint local health and wellbeing strategy. We will be asked to improve this later on, but I will let Dr Gosh introduce this, please. So, I feel particularly proud about this. This has come back a number of times to the health and wellbeing board and members here have heard it a lot in other spaces as well. So, I'm not going to go into it in too much detail, but I do want to mention that this is a testament to a lot of people working in a generally integrated way in order to develop this piece of work. Now, it has wide support. Honestly speaking, this is the first strategy that I've been involved in, which has this level of senior engagement, as well as engagement through all the settings. A lot of work has gone into it. It is the blueprint for how we're going to tackle health inequalities and improve health outcomes in Kent and Midway. At a time when resources are very stretched and it's a very challenging environment, this actually brings to focus what we can do together, so that whole motor of together we can, even if resources are strained, if we just rally and work and support each other and do things a bit differently, it can still nonetheless have big impact. Like you said, Dan, this is also the joint health and wellbeing strategy for Kent. A decision was taken that since Kent area covers a really large part of the integrated care system footprint, that we'd have a single strategy then have a separate health and wellbeing strategy, so this forms that function and obviously that is a strategy requirement of the health and wellbeing board, hence it's come here. I mean, I've got my colleague from the ICB multi-out here, so she might want to say something from the ICB point of view. Thank you, Angen. My only comment is that I have recently joined the ICB last year and having heard that this is the joint health and wellbeing strategy, as well as the ICS strategy really encourages me, because this is about improving outcomes for our population and shows the strength of the partnership in Kent. So thank you, Angen. Thank you. Do we have any questions or comments? Have to, Bob? I think it's excellent. I really like the way it now has absolute measures in it. Thank you for that really good. My question is what next? A lot of those outcomes are smart, specific, measurable, relevant and so on. When are we going to measure who's going to do the measuring and what will happen if we don't succeed to hit the targets? Good question. You can answer that, Angen. Some of the answering will happen in the next section because it's about the shared delivery plan, so I'll leave it to that. But one thing I will answer is about who's going to do it. There is a strategic oversight group which meets regularly and underpins this piece of work. And a lot of the kind of internal machinery around monitoring, working on what's happening and what's not happening will be happening there. The overall accountability is to the integrated care partnership and it is a regular item to come there and for the partnership to scrutinise it and kind of understand it and again work out some of the challenges which might come up. Roger Gough. Since I'm Chairman of the President of the ICP, I can't really ask any questions about this one. It was more just a comment which is, I think everyone around this table will remember that this is the second iteration and in some ways we learn, well, if I say we learned lessons from the first, that is not to suggest that the first one was under the circumstances put together efficiently. It was simply the fact that the requirement on all integrated care systems was to produce a strategy at this somewhat madcap pace of the end of 2022. And therefore, inevitably there were real limitations on what could be done in terms of getting this beyond the levels of severely broad aspirations. I think actually under the circumstances we probably did about certainly a reasonable job, perhaps as good a job as we could. But I think there's been a great deal that's benefitted from this in terms of this is benefitted from, in terms partly of the engagement that took place on this. And secondly, coming back to Bob's question and what we'll consider in the moment, trying to tie it much more to deliverable outcomes and an action plan and so on and so forth. So I think those key questions of, is this something that's been more widely engaged on, subject to the limitations you always have, or how do you engage on a high-level strategy, multi-partner as well across a population of, for Kent and Midway, 1.9 million people. It's, you know, it has its limits, but nonetheless I think there's been an important step change on that. And as I say, I think the rest of the process that there has been has got us to a much better place. And what we, what is also important for its implications as to how the Integrated Care Partnership works. So we had recently, we've shifted our way of working. So there will be elements where there's just straightforward reporting, particularly actually on aspects of the delivery plan. Also more wide-ranging participatory workshop type sessions that pick up particular major projects and aspects within this. So the very first of which addressed, you know, work and health. And I think that itself suggests that we're getting to a better place in terms of how all this is structured. So I think it's been obviously quite challenging for this board because we are accepting this meanwhile also as our health and wellbeing strategy. But I think it is a big step forward and it's important to see how that's come about given that the first iteration, as I say, had to be done under quite constrained conditions. Absolutely. Thank you. Any other comments? Okay. Well, let us get it signed off then. So the Health and Wellbeing Board is asked to approve the Integrated Care Strategy in its role as Kent's joint local health and wellbeing strategy per Appendix A. Everyone happy with that? Fantastic. Thank you all. Your support. Move on to item 10. As Dr. Go said, this is very much related. So this is the draft Kent and Midway Integrated Care Strategy/Joint Local Health and Wellbeing Strategy delivery plan. So once again, in general, I'll pass over to you to introduce it. So this is the, so this partly answers Bob your question. So this is the work that's being done to put the strategy into action. So it is the shared delivery plan. It is for the board to note that it's very much in draft stage. There's an awful lot of work going on as we speak to develop it. The timeline for development is pretty much the end of May, early June for this piece of work, and it's going to go to the Integrated Care Partnership for agreement and then so forth into the various statutory bodies decision making process. So at this stage, it's more for noting, but also for commenting on, and we welcome ideas and suggestions. It is underpinned by a logic model. So it's there in the documentation. So the logic model is called log frame out here and it has a set of broad outcomes and then smaller, more detailed outputty type outcomes as well, which then contribute to those broad outcomes. Like I said, it's currently under development. The challenges in creating a document that synthesizes the Kenton midway wide actions, as well as what needs to be done on a local and a hyper local footprint. So the big and the small and the breadth and the depth. So naturally con encompass everything, but under the shared delivery plan, the vision is that it will sit under it will sit a number of individual plans. So like I said before, each health alliance is working on developing a local plan for each district. So that's a set of three to four priorities with actions to be delivered in the next two to three years. The time horizon for the shared delivery plan is about four to five years, and it is a living document. The other organizations are developing plans that underpin the shared delivery plan are the parish councils through Calc. That's the Kent Association of local councils. Kent County Council itself will have a plan and that's being developed. The ICB forward plan, which multi will presently talk about is also encompassed in this, as well as in due course plans with the police with Kent housing group. And we've got a number of subcommittees sitting under the inequalities prevention and population health committee of the ICB. And that is also having plans and those plans also are part of this whole bigger picture. So at this point, it's for noting, I'm aware that I've got my colleague online, Mike Gaugaty, so I just wanted to introduce him. He's the person driving the work behind the scenes and has a lot of the detail of what this entails and will help me answer questions. He might want to come in as well, but I'll first pass on to Malte. Thank you again, Angen, and thank you, Mike, for your contributions in progressing this work across the partnership. So from NHS perspective, as Angen said, that we are legislatively required to produce a joint forward plan, which was for the last previous strategy. This year, given the partnership has strengthened as demonstrated through that we have got a joint ICS strategy, as partnership across Kent and Medway, we have decided to have a shared delivery plan, which is what you have in the pack. So however, we are still legislatively required to demonstrate that we have a sign off from our statutory partners for that plan. So instead of producing a separate joint forward plan, we are going to be submitting this shared delivery plan as our plan from the NHS to NHS England. As Angen said that this is a plan in progress, we would really very much welcome comments on this and any further information that is required, so that when we have to submit which is towards the end of June, coinciding with the ICP sign off, that we are then able to submit this to NHS England as our version of the joint forward plan as well. So that is what I would request that when in due course, when we are ready, the Health and Wellbeing Board is able to sign off this as our joint forward plan as well. Thank you. Can I invite Mike to say something? Do you want to add anything? I mean clearly this is all about community health, wellbeing, and at the moment we have got issues and we do need to kind of really move to a place where everybody is playing their cards and talking as well as a determinant. So as the leaders said just before, the fact that focusing on work and health is really important for the fact that we are getting the NHS funds into that area about thinking about this and really important minded determinants. I really commend this action plan, I think it is for all of us to deliver on it because this copy done by one organisation, it's important that the districts, the parishes, communities and as we've discussed about even individuals really step up and take responsibility for improving the health of those who serve, but I commend it too, but really welcome you for the comments and really benefit from this stage. Thank you very much. Thank you, Mike. Thank you for your input on it. So I'll open it to questions. I think first of all we've got one online before one in the room. I'm imagining that's Angela. If you'd like to ask your question, Angela. Okay, maybe we'll come back to Angela. Sarah Hammond. Oh, that's all right, Angela. We've got you now now and clear, actually. So, yeah, please, far away. We have talked quite a lot in the ICP about individuals taking an interest to put it mildly and some sort of responsibility for their own health. I ripped through the documents last night and it sent to me that we needed to make sure, going forward, that we do look at a holistic approach and make sure that we join the dots. We are looking more and more at diagnostics. We will, on the other sheppy, when we finish building it, be getting a diagnostic hub. So, great. I could, I could be referred and have a MRI scan in a week or a CT scan in a week. If I then make four or five months to be called into the pictures, say, to be discussed, I'm going to get pretty knocked about it. So, when we put these things in place, I suppose what I'm saying is that we need to make sure that the things further down the line are also in place. Because if you are encouraging people, and we have got a lot of stage fours on the ICP, so we need to encourage people more and more to, well, there's a ban there, go and get it done. We need to encourage you to get your diagnostics as early as possible, but if there is then a log jam going forward, it doesn't do too much for the enthusiasm of people because, as we all know, if you have a good experience, you tell one person, if you have a bad experience, you tell a hundred. So, we need to encourage people to get the diagnostics, but there needs to be the stuff further down the line to actually deal with whatever those diagnostics say. Thanks, Jeff. Thank you, Angela. Would anyone like to comment on Angela's points there or we're just noting them? Noting them. Okay. Okay, noted. Thank you. In that case, I'll go to Sarah Hammond in the chamber. Thank you very much. Sarah Hammond, I'm the Director of Children's Services here at Kent County Council. I'm going to caveat what I say by recognising that this is a draft, and then secondly, say how delighted we are to see children through so loudly. But actually, it does indicate the real challenge we have with two separate regulated services across Kent and Medway. And particularly, I'm looking at page 71, when we are, we've got some percentage targets, for example, for rate of children in need similar to national average child protection plans and children in care. So, for us here in Kent, I'm very pleased to say we're an outstanding children service, we are well now ready. In fact, we sit below the national average in a good way. So, we're going to need to be able to, if we're going to report meaningfully, separate out the two local authorities. It's not something that can be done at a district level, but it is two things that the two Medway and Kent County Council report on and are held to account separately. And it's to do with the degree of regulation that children's services are under. So, just some thoughts really about that. That's a very good point and engine. Yeah, so a very good point. So, like I said, and Mike's engaged with the with your team as well, and your DMT is the separate KCC plan will be reflecting that. So, it will be having a section on children's old get on adult social care and public health. So, it will cover it there and we'll make sure that that separation is very clear about. I think in general, the spirit of this always has been that it's a partnership respecting the sovereignty of individual component parts. And this is part of that sovereignty piece. Thank you. Thank you, Chairman. So, it's really good to see this delivery plan because because in effect until you see that until you see how you're going to do it, you can't. It's not meaningless, but it but it doesn't actually resonate. Does it? And there's a huge amount of detail in here. I think therein lies potentially some of the difficulties going forward that there is so much and the difficulty of collectively making sure that all those organisations that are listed in the led by column are actually able to contribute to meaningful outcomes at the end of the day. But equally in reverse and I think so it was interesting to hear and you talk about Calc. So, in the last couple of weeks or so, it's the privilege of County Councillors to go and report to annual parish meetings and I have several. And I've included this in my not the delivery plan, but I've included the strategy in my report. And you can see on people's faces that it's effectively going over their heads at the moment. There is very little recognition or to a certain extent belief that this is anything different despite a couple of examples about why it is different and what it's going to do. And so, it's finding a way of relating what is the huge amount of stuff in this delivery plan that's going to be delivered to the fact that it is part of a new plan and it's part of a different way of working. And there'll be constructies, you know, galore, alongside this and are not part of the delivery plan and nor should they be because it's about delivery. It does talk about the family. It does talk about creating the family and using the family as a. But I think that that work, that ongoing work and that work to make sure that all those organisations that are part of this recognise that there's a place for. And creating understanding that things are being done differently is going to be absolutely key because otherwise all our residents out there. You know, going to continually talk about the individual things that bother them on a day to day basis and not recognise that actually there is a huge amount of stuff that's going on to do things differently and it is being done. So, you know, I just wanted to make sure that it's not forgotten in the actual, in the actual doing of which there is a huge amount in here. And also the relationship back to individual responsibility. And I think that goes, so I look at the children's outcomes there and clearly within that it's new initiatives like the family hubs and the joined up working that we're doing there. But again, there's something in there about creating an increased sense of responsibility within families too around and recognising that there is that interrelationship that is going to be crucial to getting the improvements in outcomes. Go on, Jim. All really important points. There is a little bit of trying it out and seeing because it's a very new way of working and it is complicated and messy and everything. I've kind of professionally and my team as well have decided to embrace that complexity and not fight it and work with it. So I think some parts will emerge stronger in terms of delivery and some parts will lag inevitably. So there is a little bit of seeing how it goes in, but you're right in all the things you're saying. In terms of the parishes, I do want Mike to come in because he works very closely with the parish council councils. I think what you're saying is true because there are 300 plus parish councils, isn't it? So it's a real complexity in itself. How do you actually individually kind of link with 300 plus parish councils, but we're doing it through Calc. So to some extent it's how effective Calc is at doing that as well. But Mike, you might want to come in on that. I think there's something about blends here and I think cast chat. The real position is this is everybody's strategy. So the local parishes, the local districts, they know what they've got to. So it's not really holding people accountable. People say, this is what I'm going to do. This is my contribution. This is what I'm going to do. So if we end up with the association local councils, they don't really need to see an understanding of what I'm going to do or something. They need to understand what they've chosen to do and what their parishes are. And indeed they've chosen by priorities, which they're going to work on with the parish council. I think that's great because they've chosen that it's what they want to do. I think it is really about those communities, those individuals doing what they can to improve their own health well-being. So great example, this is weight management. Two thirds of adults, eight in country weight abuse. And with the best intentions, we can commission services for a few thousand. We're talking about hundreds of thousands of people who need support. Now, we're actually using wages in rocket science. It's hard to do, it's not rocket science. You just need to make less calories than you do you expend. So actually, this is about communities. It's about peer support. It's about people helping people. And that's the only way in which we can land things like this. And that's not the example. This is a real sea change in terms of recognising if you're willing to shift the balance of health and well-being of the population you serve. It's for everybody to play their role. The parishes, the districts, for ourselves, the NHS colleagues. I think this is a really exciting opportunity for the three of them. But it's a bottom-up thing. It can't just be the ice machine saying that this is how it is because they didn't work. I think we might have a couple more points on parishes before we move on to Roger. Roger, is your point on parishes or is it a separate kind of thread? Mine is a whole series of threads. So that's best if somebody else gets to go first. I think Sue was going to come back. Yeah, OK, so we'll wrap up. Actually, I had a comment as well. I absolutely agree. And I think what Mike is saying is really good here. And I'm really pleased to hear it. So I'll watch that with interest. Because I suspect that we're at the very beginning of that process right now. And so next year, when I go to all my parishes, I'll look forward to the sort of response being a little different. But you're absolutely right. It has to be from the bottom-up. And that addresses, to a certain extent, my point about individual responsibility as well and that point. So thank you very much. Thank you, Sue. Thank you, Sue, and actually, I wanted to just sort of give a shout-out for unparished areas. I represent Herne Bay. There are quite a few predominantly urban areas in Kent, which don't have a parish or a town council. And therefore, when you're completing the delivery plan, obviously, don't forget about us. Any responsibilities for parish councils will probably need to be escalated into the district council or elsewhere. Because, yeah, we just don't have those frameworks there. OK, fantastic. Lots of speakers. So let's move on to Roger now. Thank you, Dan. It's a series of points, really. I mean, firstly, as I think we've mentioned, worth remembering, this is still very much a draft. And I think you can see it's worth in progress in the log frame matrix, for example. I think we've still got a reference, though it says it's going to be superseded to a target, which I think quite early on, actually. We decided didn't quite get it right, which was the movement in relative income per head. I think it was between ourselves and the national average. And I think that looked both really quite hard to see how that was within our control at all. And quite ambitious as well, actually. So now that's going to get superseded by what's within the Midway economic framework, including the whole number of those sort of areas. Picking up first on some of the things that Sue was just discussing, because it came up a little bit on, in some conversations I was part of yesterday, which is the whole question of how we get that wider engagement. And as I mentioned a few minutes ago, doing it for an organization or a grouping of this kind, multi-agency, broad brush strategic, very, very hard to do. And as I recall from my times of chairing this Health and Wellbeing Board, it's because it's a multi-agency body. People know what the local NHS is, though they may not perhaps realize all the sort of subsets within that, but they certainly have a concept of the local NHS. And certainly for councils, it's pretty clear who we are. When it's multi-agency, it's a lot harder. At one point, which I know was discussed quite a bit in the conversations yesterday, was linking some of this. And perhaps we've already missed a small trick on this, which with the session, the ICP session that we held here a couple of weeks ago, it's trying to something specific. So if you've got something in relation to, in that case, it was work in health, then I think the opportunity to give that a degree of oxygen is not as an opportunity passed forever. There's going to be plenty more work in that space, so I think it can be done. But it is, I think, that degree of specificity, given that we are, at the same time, a multi-agency group, is really, really important. Turning to some of the areas of work here, interested just, again, to explore a little bit of what's been said already, which is the how. If you take what I actually think is an admirable target, which is linked to, I think it's 2.1 and shared outcome two. It's 20, 28, 29, by, so by 28, by 20, 28, 29, the proportion of people who feel lonely often or always will have reduced from 7.3% to no more than 5% across Kent and Medway. That's quite an ambitious target, but not, I think, unachievable. And it's in a really important area, because, again, I don't need to be a public health expert of the kind that we have in the room to know that we've often discussed just how lethal loneliness and isolation are for people. So I think this is, again, something that must be brought out as part of that sort of wider bottom-up approach, a little bit along the lines that Mike was talking about and whether it is very local bodies. But how exactly we put the flesh on the bones between that ambition as we set it out there, and then it lists some of the strategies and who it's led by, et cetera, et cetera. I think is an interesting one. I would raise a question, which is a couple of points. So we look at the lead by. This is one of those areas where we, although actually we talk about calc loneliness initiatives, we don't really talk about calc or parish councils among the leaders on it. And also slightly puzzled as to why, quite rightly, we've got, from a KCC point of view, adult social care in there, but not our public health team. And I'm just slightly puzzled as to why that would be. But I think that whole question of how this sort of thing is generated, I think as a kind of bottom-up initiative is something which will be very important to understand and to follow, not to try to fully control, because that way lies generating a bureaucratic process that will probably strangle the best of initiatives, but certainly to understand it, because I think this is the sort of initiative a little bit like what Mike was saying about weight loss, which can only be generated by that much wider community action. But if it does, really, really will then generate some significant benefits. My final point, which is something quite different, going back to the children's side and listening very much to what both Sue and Sarah were saying. One question, which is, do we at the moment take into account, and this is something which I've been focusing on elsewhere quite a bit recently, the question of support for young people with the more severe mental health needs, because there is no doubt that many of those people seem in many ways to be falling, and some of the most generally vulnerable young people. I think as we've discussed, those young people are now, thank goodness, no longer part of the criminal justice system or quite the scale that they once were. We've had things like post Winterborne View, all the work in that space to have more community-based responsibility for dealing with those issues, which, again, is the right thing, but I think many of us would question whether we've really got there yet. And I just wonder whether what we have in here at this stage, and this is a quite recent reflection having had reason to look at this issue separate to the work done here, whether we've quite got enough on how that particular initiative might be dealt with because, or issue might be dealt with because I think it is something that is a genuine, quite serious issue for many of our young people. Thank you, Dr. Gesh, you want to reply? So, thanks for a lot to think about. I've noted the points, a lot of them I can't answer immediately. In terms of the exploring house, or just as an example, this is where those underpinning plans come in into action, because a lot of the district plans have titling loneliness and isolation there. I think the CalP plan also has prioritized tackling loneliness and isolation. So, if you're going to the detail, the detail is actually in those layers. Similarly, I think it's fair challenge that public health is not specifically mentioned, it should be. We don't directly commission anything to do with loneliness and isolation directly, but indirectly through live well Kent, as well as through the public mental health bits. I'm trying to really put some sort of, you know, kind of a more cohesive approach to will include this as a natural consequence. In terms of the specificity one, I think the way the integrated care partnership is doing the Pan Kent Medway piece, because there are things which are more amenable to a Kent and Medway type approach, which is what's being captured in those workshops. And then there is the detail in terms of specificity, which would be local. So, for example, I mentioned it in my briefing for Thanet tackling suicides, for an example, an important area. So, those are, again, locally determined. So, we're providing the data and we're providing the comparisons, and then there's local intelligence that each area holds. And it's like marrying those two up to get to a set of priorities and then actions at that level. So, I personally put a lot of a kind of energy and credibility into those plans being the vehicle for delivering this. Which is not to say that at different levels there are other things which are happening like hate CPs as well as primary care networks and primary care itself. We're also working, say, which is not yet reflected in there with the integrated neighbourhood teams, with adult social care in a different way. All of that is happening. In terms of the children's one, I was going to turn to children's colleagues for a bit of steer on that, but definitely, I mean, this is over and above business as usual. So, that might be part of it, but equally might not be. So, there's absolutely no doubt that we have a cohort of children increasing cohort of children adolescents who 10 years ago would either have been in the criminal justice system or would have been in secure hospital tier 4 placements. And a lot of work from those two agencies to reduce the number of children in those placements with an original ambition that they should be living out in the community. The reality is, for many, many of those children, they're living in a different type of institution. And in some regards, more worrying, if I'm honest with you, both in terms of the type of provision that we're having to buy for them, the cost. And we're talking about loneliness, but the isolation of those children, they are, for the most part, living completely on their own. So, there is certainly something about a collective response to those children, often with comorbidity of mental health, some learning difficulty, some adverse childhood traumas coming together to create the circumstances that they find themselves in. So, absolutely, that's a focus for us. Thank you, Sarah. So, you wanted to come back on that point? So, I was just going to take that conversation a little bit further, if I can. So, that's where we find ourselves now, and we've had quite a bit of discussion about that particular cohort of young people recently, and they're significant in lots of ways. Sarah was talking about the reasons that those young people find themselves in that position right now. Now, I suppose there is an aspiration which is evident in the family hub scenario, which is where there is very much increased emphasis on parental support, family support, as well as support focused and targeted support for young people with particular problems, and that's quite deliberate. And I suppose there is, and it's an aspiration rather than expectation, probably, that that increased focus and slightly different sort of way of delivering may actually reduce the incident of that particular issue as children get older. And certainly, I've come across a couple of examples recently where one could envisage the intervention of a different kind earlier on in that family's life could have actually prevented that young person from getting to that point. So, there's two things to deal with. There's a sort of, you know, there's a long-term plan, if that makes sense, which is very much part of that. And there's the how we properly make those of the children who are already in that scenario, how we make their lives a little bit more meaningful, maybe in the short term. Thank you. Okay, we've got several more speakers. So, over to you, Bob. Thank you. I do like the, what you said, Mike, about this being everybody's strategy. I think it's a really good place to start. I'm going to slightly cheekily ask, do they actually know that it's their strategy? But moving on from that, I'm looking at, for example, pay. Oh, it's gone. About 116, 115, work in a more integrated way. I just need to flag up. So, I'm the child safeguarding lead for our practice. I'm very fortunate that I have a good relationship with a health visitor who works in summary roles and who I have regular meetings with in order to discuss the vulnerable children on our list. I mentioned this at the West Kent safeguarding children's forum that meets roughly every two months and is educational and supportive. And they said, wow, you see your health visitor. So, none of the other people attending about 30 or 40 people have regular contact with their health visitor or a health visitor who works with their children. So, it's just, all I'm saying is that this is absolutely the right place to start. It's highly aspirational and it's absolutely what we should be doing. I'm just saying there's many a slip and we need to be really careful that everybody understands that this is how we are now working. Everybody accepts this is how we are now working and everybody shares our enthusiasm for this is how we should work. Yes, thank you. What Mike do actually Bob is, I'll take Morti's comments and then Mike and then if anyone wants to respond to any of them as a group, that might work quite well. So, Morti. So, Mike, really, my response was in relation to some of the comments that I've heard. So, Chair, if you wanted me to come at the end, I'm very happy to. Yeah, why don't we do the why don't we have the Councillors comments first and then that actually might be good to bring you in then after. Thank you. So, my point is really about the local and how local and how you monitor and track progress, which is important I think in terms of keeping everybody motivated in all this and seeing what we can achieve. So, in Feudson and Hyde, we've had one kind of inaugural meeting of the Health Alliance, which was a great meeting, but I think there was recognition within that meeting that a lot of the change we're talking about is very long term. So, that's my point really is, how can you track that progress you're moving the dial, but moving the dial very slowly in two to three years or even five years can feel quite ambitious. The approach that we're taking is to make some targeted interventions on particular issues like aging well, in particular parts of the district where those things are most prevalent. So, it's a district like others. I know where there's extremes of deprivation and not deprivation. So, something's much more prevalent elsewhere. So, it is taking that local approach within the district, but making it hyper local within the district. I think bottom up is really good, but I think it would also be perhaps useful maybe once a year or something for the health alliances around the district to hear what each other is doing, because the bottom up approach is great, but you don't want to be reinventing the wheel and you can learn from each other greatly and I'd certainly be very interested to hear what else is happening in the county. And then my final point was in 5.2 on page 64, it talks about ICPs to create a forum in which partners should hold each other mutually account. So, I was just interested in what that forum might typically look like, how local is that forum and how are those partners involved in that process. That was it. Thank you. Very good question. So, let's, let's pass to Malti and then know other people can contribute after that. Thank you, Chair, and thank you for all the comments. They have been really, really helpful. Just really, there are three or four points that I'd like to summarize what I've heard and in response to what the comments have been raised as well. Just the first one, really, this is, as both Anjan and Mike have said, that this is about where our shared approach can make big difference. And that doesn't necessarily, that really doesn't replace the detailed action plans that sits behind the responsibility of the sovereign organizations. So, there is a lot of detail that is taking place across all the sovereign organizations, which they have to deliver on, which is not reflected in the shared delivery plan or in the ICS strategy because it's approaching it from the partnership perspective that where we can make collective impact on. The second point related to that I wanted to make was about the parishes that I've heard and also the localism and Anjan pointed out about the neighborhood teams. And that's really important point to, for us to be, and it is actually reflected in the document itself, that we are embarking on a journey where we are looking into how we provide care closer to home. And that would mean parishes, neighborhoods, and we are on a journey as well. So we have got different strategies going on at the moment where we look into transformation of services, not just in healthcare, but how do we work with our partners in transforming those services to improve outcomes for our local population. So that's a piece of work that is ongoing and will continue to take place and hopefully will reflect that how we are responding to local populations and needs. With that in mind, I'm also going to take an action. I'm going to make sure that Mike is in touch, I will put Mike in touch with our Director of Primary Care to make sure that those links are then strengthened where they can. The other point that I really want to reflect on is the point that has been talked about children and young people and mental health and also the integrated side of things that Bob raised. And the lead responsibility or in the lead by column, you would see that there is mention of provider collaboratives. Now provider collaboratives are another, it's bringing providers together as a delivery mechanism for improving outcomes as well as transforming services, but it's early stages. So those provider collaboratives are being formed, partnerships are being developed, and discussions are taking place. But it is a way, a space to watch that, you know, and in fact the action we need to take is to share this shared delivery plan with those provider collaboratives and structures to ensure that they are then able to take the requirements into account as they shape their own deliverables and shape their own delivery vehicles. So that would be an important thing, and again, I'll make sure I'll take that as an action from ICB perspective that I'll share the plan as well as the ICB strategy with the provider collaboratives. So these are the things that I wanted to come back. Thank you. Thank you, Milton. Thank you for volunteering to take action points away. They are always welcome. Yes, I thought, Jyn, maybe if you give your comments on the last few speakers, that would be great. Thanks, Dan. So specifically focusing on Councillor Blake Moore's points, so really glad about the folks in high alliance. You've got a brilliant officer there, Jotzna, who's driving it, and I mean, I think every district needs a Jotzna. In terms of monitoring outcomes, that's one of the challenges, but I think the way around it is at the, especially at the level of districts, that you said it yourself in terms of targeted and hyper-local actions, is to limit the number of actions, have a few deliverable, achievable, measurable actions, which are there, and then it's easier to monitor that and collecting that information. We are actually thinking about this idea of, at some point, not now, but once the partnerships mature of having a summit of some sort of all the districts, for the very same reasons that you just said, and also to take stock and perhaps to celebrate what we're achieving or the movement we're creating. I know that with Roger here as a leader and as well as a former chair of the Health and Wellbeing Board, so I just wanted to plant the idea because, I mean, the way the integrated care partnership is evolving, which is great, the way it's doing it, there are certain things which, which, where that couldn't be discussed in more detail. So, for example, the work that's going on with districts, with health and care partnerships, which is very kind specific, and it could be also to do the volunteer sector and KCC itself, in fact. And perhaps there's a role for rethinking. I'm not saying we have to, but just planting the idea of the Health and Wellbeing Board being that place, where that kind of a convening power is there for this potentially, because there is a gap there. Otherwise, there's no particular democratically accountable place where this is kind of held. Does everyone else want to talk on this topic, not withstanding the fact, there's been a very good conversation, lots of feedback. We could immediately input as the strategy delivery plan concludes. Maybe it's too early to start talking about it concluding. Progresses, progresses. Okay, I think that is everyone who's spoken. So, yeah, thank you, everyone, for a really good. Oh, go multi. Apologies for interjecting, but I just really wanted to make sure that because we do need formal sign off from Health and Wellbeing Board, I just really wanted to make sure that it was noticed as an action that if there are any further comments, then to please send them to Angen as our DPH so that they can be logged in properly and further. Those comments can be taken off in the final version of the plan before we submit it formally. Thank you. Certainly, we will minute that and given we don't have any other comments, let's move on to the recommendation then to that end. So, we are asked to, one, note the progress and proposed work in developing a shared delivery plan for the integrated care strategy. Two, consider their role as partners in delivering the strategy and how they could be reflected in the delivery plan. And three, support the continued development of the shared delivery plan alongside the logframe matrix to support assurance on delivery of the integrated care strategy. Everyone happy with that? Excellent, might be the... Go on, Mike, did you want to say something? Go on. My area is in addition, I'll ask, sorry, which is that it may not be an action for the state, but what's one of the pieces, the early slide you might notice has a sort of comment and a piece on the health and wellbeing board about the plan and how they think about it. And I think we would, it would be great if perhaps your good self might be the drafting of a statement based on what to say about our positivity around the structure, our positivity around the plan, how we see critical to learning where we have improvements and how we see issues on the health and wellbeing structure as well. I just think that sometimes needs to be greater and less that we can put in, but we could be up on separately with the mission of the board. Thank you. Good suggestion, Mike. People happy that we include in assigning this off as it were, a positive statement about our collective support for the strategy and the direction it's going in. Okay, fantastic. And just to be clear, everyone also supports the three recommendations. Okay, fantastic. Thank you, everyone. And we should do so, Mike. Thank you for that. And thank you for joining us. You're very welcome to stay for the last item as well. That might be the last time I say integrated care strategy today. So here we go. The final item last, but not least, we have the Kent and Medway safeguarding adult board annual report for 2022, 2023, and we have two external colleagues joining us to present it. Andrew, and Victoria, and we have a recommendation at the end to consider and endorse it. But if I pass you over to Andrew, I'm sure you will be happy to open up. Thank you very much, Chair. It's very hard to follow that in relation to the debate, the discussion that you've had. But I mean, I would just say, and it strikes me straight away that the connection between safeguarding and health and well-being is so important. I mean, we've recently had Jess Mukherjee come along to our board, come along to actually talk to our working group for our SARS to talk about some of the initiatives and the work that are going on around suicide, alcohol, and substance misuse, because we see them come up a lot in our safe, we've got an adult reviews, they are a sad reflection on what's happening, but I think we're sort of working quite closely now with public health and public health, they're actually coming to our boards, and we're able to actually use that opportunity to actually share some of the aspects of probably this plan, and to ensure that it's actually been delivered through the other agencies. So I'll pause there and go into the annual report, now you will notice the annual report is 2022 to 2023, March 2023 at that. So it is a year out of, but it's not a year out of date, this is the way we do it, it presents it, and we do present it number of times. It's a large report, there's lots of information in it, and I don't propose that I go through that detail. We have a statutory obligation as a board to present a strategic plan, which we now have in place, which is actually mentioned in the reports we just spoke about, an annual report, and a the Soaker and Anna review process. This report lays out the work in detail of things that have happened in districts, the work that's carried out across the districts, across the different agencies, and across safeguarding for adults, and there's a lot of detail. And I make an apology for that. I think it's really important that we use this to understand what actually happens in safeguarding adults across Kent and Medway in relation to this case. But I thought what I would do is take the opportunity with this group to sort of talk about some of the things we've learned, because annual reports give us an opportunity to reflect. We also carry out a SAF, which is about our questioning of all agencies about their delivery of safeguarding, and it's really important that we consistently and continually monitor the process and progress around safeguarding adults. So I thought I'd draw out some of the areas. The first one I talk about is the Save an Adult Reviews. Save got an Adult Reviews or a statutory obligation to be carried out, and we have a high number of referrals. We had 36, I think it was in the last 12 months in the last report, and converted 15 of those into actual full SARS, which is about learning, about taking that learning, sharing it across agencies. So we look at that, and one of the things that we try to do actually now is to actually join some of those themes together. So we're looking at how we join themes together to actually look at whether we can build on learning that's actually already been put in place. So the sound numbers continues to be quite high, but actually the process we put in place in relation to learning goes across all agencies and it reflects in our training as well. Another thing I always like to look at is the use of our website. We've got a very proactive website for the Kent Medway/Sacon and Adults Board, and we're able to monitor to the hits in relation to it. So we regularly have lots of users looking for information about how to safeguard adults, information about different events, different things we put on. We call it a webinar, or I call it a webinar, with the name of something else in the Kent Medway. Open sessions, which we put on in evenings, allow practitioners to come in their own time to listen to and discuss issues of safeguarding. And we put those in the quarterly area. So we're able to then monitor the website usage after those actual presentations. So that's been a tremendous success for us in relation to getting the message out to members of the public and other practitioners as well. The districts, each of the districts has a safeguarding obligation, each of the districts has a safeguarding team. They vary in size and they vary in relation to the activity. We report on those in our annual report, we report on what every district does. And one of the things that we've recognized is some really good work out there in relation to some of the districts, but there's a difference in relation to the work. So one of the things that we've started doing is going to the district forum and speaking with the district leads. We want to actually see if we can share better practice across the districts to ensure that actually the delivery is consistent across Kent using that district model to support that. Another one, if you'd look to the data you'd see, and it's interesting because I see it's a measure in relation to the plans we're speaking about, is the number of referrals of Section 42s into Kent. And last year they saw an increase of 47%. There were 15,000 reports of concerns throughout into Kent last year. And that equated to, I think, 5,000 that were converted either into a safeguarding alert and investigation and care and needs assessment, which meant that there was a large number. And we've looked in quite a lot of detail and we've challenged in detail around how that process works, why those numbers went up. And it is a change in procedure that was introduced that has meant that more people are aware and more people are referring in to that system. So in setting a target that actually is going to say a reduction in the number of referrals that may be, I'm just saying this, may be an issue because actually we wouldn't want to reduce or prevent people feeling they can report concerns they have for vulnerable adults into the local authority. It's how they're dealt with then is the issue that I was having, how those are dealt with, and what actually happens to result of that, and that's the important thing. We spoke about collaboration. We work a lot on this because we see in our reviews collaboration between services is really vital to good safeguarding practice. We've just introduced a new group which is the safeguarding leads across health, Kent Police and the local authority to come together. So a safeguarding leads come together now to talk and meet and discuss the safeguarding issues that cross over their own agencies, to see whether or not we can find when those issues arise and we need to look at how we can actually better deal with them, how we can actually deal with these things outside of the sort of more formal process to actually ensure that actually processes and systems work more effectively. And consistent themes. There's just been a national save gun review of the national save gun and adult reviews across the country and consistently that the same themes have arisen. We find that themes that come out from our reviews are issues such as self neglect, still maintains an issue, mental health, dual diagnosis, drug and alcohol misuse, still top the list of concerns that we see in relation to save gun and reviews. So a lot of the work that we do is in those areas to ensure that the delivery of work is actually consistent around those areas. Yeah, and I'm happy to take any questions. I mean the information is there, the information is in the annual report. I'm happy to take any questions anyone might have. Thank you, Andy, and thank you to you and your team for all the valuable work you're doing on the topic of safeguarding. Roger. Yeah, I'll just take out my thanks on that and it's an interesting and useful piece of work. Can I just understand coming back to one thing you mentioned, which was this big spike in referrals. And it, as I understand it shows that, as you say, there's 40 odd percent, whatever it was, rise. It also indicates that in relation to population, Kent comes in about national average on that basis, having suddenly sort of leapt up and it may be very hard to know the answer to this, but it's just interesting given that change in reporting practice, which I think you were indicating is perhaps the main driver of the increase. Do we know how those practices compare with many other areas because it would be, I mean, I think you're entirely right to say, you know, we don't want to be chasing numbers about bringing this down when actually, you know, very often with these things, it's getting this out into the open and understanding what's going on and giving people ease of reporting, which is really, really important. Were we, as far as we know, relatively late in the day and making this kind of change or ahead of many others or do we just not know? Because I'm just interested as to what, where we think we stand in relation to others and what that set of figures tells us. Vicki, a huge wish for my ear and I'm going to allow her to answer that first of all. I've got some comments to make. Yeah, I think, you know, from my understanding was at the time it was a change for consultation processes. So the local authority offered a consultation process before different agencies would make the safeguarding referral. So what that would do is actually you would imagine, wouldn't you, that actually if you'd spoken to someone, it would be those that they had probably advised that needed to go for a safeguarding process. For a safeguarding concern to be raised. So that's why you sort of, when that stops, as you can imagine, the guidance was actually we need to raise awareness amongst all of our partner agencies about what constitutes a safeguarding concern. Because actually it's about upskilling all of those partner agencies so that the right referrals are going through. So I think it was perhaps to be expected that that was going to happen, that without that sort of guidance from those local authority specialists, that that's where that came. So I couldn't think nationally. I can talk more nationally. I chair the south east of England group and what's interesting, figures are always compared across. And I've got to say, our sort of most similar sort of acreage encounters are very similar in numbers. What's interesting about safeguarding referrals, everyone deals with them differently. There's no one standard. So what you tend to find is some get referred in and then 100% become safeguarding concerns, as in Surrey, and then others triage them to actually look at what they're going to actually do with them and how they're going to do with them. Kent introduced a triage system a little while ago. So got moved away from a triage system to allow more information to be coming in. And I think to be honest with you, that was a brave decision, but the right decision, because what it allows people to do is if they have a concern, they know they're going to actually get something through. There are some tweaks to that and I think everyone would accept that. There's a lot of work gone on to do that. And there are some other agencies that don't follow the process that actually we would like them all to follow because of just internal mechanisms of working. But we, I think as a board, because we want to deliver and ensure the delivery is based upon the needs of the individual, we can focus on that to say, so how is that being addressed? What's happening to those 10,000 that don't get looked at and how are we making sure that those people are actually picked up as well? So, so there's lots of things it tells us. I would say to you directly to the question you asked, we're not out kilter with anywhere else. And everywhere is seen in the increase in relation to referrals, an increase in SARS, and an increase in some of the complexities that need to be dealt with through the safeguarding process. Thank you. We have Angela Harrison online. Can you hear us there, Angela? I can hear you now, please. I am waiting. My camera is on. I am waiting for open reach, so I could walk down. Okay, we'll give it your best shot. We, we... I think the key has got to be awareness, and I don't think you can have enough of it. And am I still coming through because my screen is frozen? You are. I can hear you. Can you still hear me? Yes, we can hear you, Angela. There's a little bit of a delay, but that's not a problem, so keep going. Very excellent brief member briefing when I was at County Hall a number of years ago on CSE as a result of which myself and the leader at the time who were there went back to Swell and instituted awareness training for taxi drivers as part and parcel of their license application. And reading that report, I will be going back now and adding the adult safeguarding into it. I think districts will come across more self neglect and hoarding issues, but members don't see them as self neglect and hoarding issues until they're bashed on the head with it. What they see it as is neighbors complaining about the state of your property and the rats that are coming into mind. So ultimately you do get to people, but the awareness needs to be, not there's rats coming from your property, sort it, but have you got a problem, how can we all help you? Because it is an adult safeguarding issue, so the more awareness there is of all these things, I think the better. We do at Swell and I hope the other 12 districts do too, have an annual adult safeguarding and indeed children safeguarding briefing for members to keep them up to date. So I hope that happens in the other districts, so it's a really good report, taste studies excellent, and it's just more awareness, you can't have too much awareness, thank you Chair. Thank you and agreed, and you've got a comment. Just a quick comment, I've got Vicki with me, here's the author of the report, so she should be thrilled to hear the comments you've made. And in relation to self neglect, it's an area that we push, our training is focused on self neglect, a lot of the inputs we do are about self neglect, and a lot of our safety and our reviews feature self neglect. You'll be pleased to know that our strap line is noticing, is not nosiness, and actually that's something that goes out to on everything we send out. We attend things like the police open day, where we talk about safeguarding, we do a variety of different events to ensure that we get that message out, but thank you for your comments and I agree with you, we can't talk about too often. Yes, thank you and looking through the report actually it's very notable just how much training is going on around the district and all agencies vast amount as it should be. Did anyone else have a comment or question? Okay, then let's move the recommendation, if we may, the health and wellbeing board is on to consider and endorse the Kent and Midway safeguarding adults board annual report 2022 to 2023 attached as appendix a to everyone happy with that. Thank you very much for your support, and once again thank you to Andy Victoria for joining us today, and I dare say we'll be seeing the 2324 report quite soon. Great, okay, well that's the last item, so we will close the meeting now, nothing else to do today, so Georgina, no. Okay, well thank you for your attendance in the room and online and have a good rest of day.